| NPI | 1114422854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 12760433-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL TRN28888) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2022-07-08 |